The quest for synergy between physical exercise and cognitive stimulation via exergaming in people with dementia: a randomized controlled trial

Abstract

BackgroundExercise is often proposed as a non-pharmacological intervention to delay cognitive decline in people with dementia, but evidence remains inconclusive. Previous studies suggest that combining physical exercise with cognitive stimulation may be more successful in this respect. Exergaming is a promising intervention in which physical exercise is combined with cognitively challenging tasks in a single session. The aim of this study was to investigate the effect of exergame training and aerobic training on cognitive functioning in older adults with dementia.MethodsA three-armed randomized controlled trial (RCT) compared exergame training, aerobic training and an active control intervention consisting of relaxation and flexibility exercises. Individuals with dementia were randomized and individually trained three times a week during 12 weeks. Cognitive functioning was measured at baseline, after the 12-week intervention period and at 24-week follow-up by neuropsychological assessment. The domains of executive function, episodic memory, working memory and psychomotor speed were evaluated. Test scores were converted into standardized z-scores that were averaged per domain. Between-group differences were analysed with analysis of covariance.ResultsData from 115 people with dementia (mean (SD) age = 79.2 (6.9) years; mean (SD) MMSE score = 22.9 (3.4)) were analysed. There was a significant improvement in psychomotor speed in the aerobic and exergame groups compared to the active control group (mean difference domain score (95% CI) aerobic versus control 0.370 (0.103–0.637), p = 0.007; exergame versus control 0.326 (0.081–0.571), p = 0.009). The effect size was moderate (partial η2 = 0.102). No significant differences between the intervention and control groups were found for executive functioning, episodic memory and working memory.ConclusionsTo our knowledge, this is the first RCT evaluating the effects of exergame training and aerobic training on cognitive functioning in people with dementia. We found that both exergame training and aerobic training improve psychomotor speed, compared to an active control group. This finding may be clinically relevant as psychomotor speed is an important predictor for functional decline. No effects were found on executive function, episodic memory and working memory.Trial registrationNetherlands Trial Register, NTR5581. Registered on 7 October 2015.Electronic supplementary materialThe online version of this article (10.1186/s13195-018-0454-z) contains supplementary material, which is available to authorized users.

Individual Differences in the Effects of Physical Activity on Cognitive Function in People with Mild to Moderate Dementia

“…Fourteen participants (12%) did not complete the training and were excluded from the analyses. A full description of the reasons for drop-out has been provided previously [6]. Main reasons for drop-out were comorbid medical or physical problems and lack of motivation.…”

“…Uijen et al / Individual Differences in the Effects of Physical Activity benefit most from physical activity interventions and can help develop individualized training programs accordingly. The objective of this secondary analysis of a previously published randomized controlled trial (RCT) was to examine whether the effect of physical activity on cognitive function in persons with mild to moderate dementia is moderated by patient characteristics [6]. It was hypothesized that combined physical and cognitive exergame training would result in larger improvements in cognitive function than physical training alone.…”

“…There is growing evidence for this in healthy older adults and in people with mild cognitive impairment, but this effect is less clear in persons with dementia [7]. In the RCT, an extensive neuropsychological test battery was administered to evaluate the cognitive domains of executive function, episodic memory, working memory, and processing speed, as we expected a differential effect of exercise interventions on these domains [6]. The main outcome was that both physical intervention groups (combined cognitivephysical training and aerobic training) improved equally on psychomotor speed, compared to an active control group.…”

Effects of low- and high-intensity physical exercise on physical and cognitive function in older persons with dementia: a randomized controlled trial

“…Studies specifically in daycare or residential care settings are scarce. One RCT in PwD attending daycare showed that aerobic training had favorable effects on psychomotor speed only [82]. Altogether, there is a lack of convincing evidence for the efficacy of exercise for cognition in PwD.…”

High-Intensity Interval Cycle Ergometer Training in Parkinson's Disease: Protocol for Identifying Individual Response Patterns Using a Single-Subject Research Design

“…Accumulating scientific evidence supports the use of physical rehabilitation training and exercise as an effective nonpharmacologic therapy to improve motor symptoms, problems with mobility and gait (49,50), and non-motor features, including mood, cognition, and sleep [for review, see Reynolds et al (51)] for patients at all stages of PD. Intensive exercise may even induce neuroplastic disease-attenuating effects via endogenous production of neurotrophic factors, including BDNF (4,5,52,53).…”